Welcome to my blog, which speaks to parents, professionals who work with children, and policy makers. Through stories from my behavioral pediatrics practice (with details changed to protect privacy) I will show how contemporary research in child development can be applied to support parents in their efforts to facilitate their children’s healthy emotional development. I will address factors that converge to obstruct such support. These include limited access to quality mental health care, influences of a powerful health insurance industry and intensive marketing efforts by the pharmaceutical industry.

Thursday, March 1, 2012

Postpartum Depression: Bringing in the Baby

I recently had the privilege of being appointed to the Massachusetts Commission on Postpartum Depression (PPD). The Commission, co-chaired by Rep. Ellen Story (Amherst) and Senator Thomas M. McGee (Lynn), is charged with making recommendations to the Department of Public Health and the MA State Legislature on advancing best practices regarding PPD screening, treatment and public and professional education. I am on the public education subcommittee.

Lately I have been writing a lot about love, and this new role brings me again to this subject. When we support caregivers (I use this word rather than mother, as while the primary caregiver is usually the mother, it may be the father or another relative) who are struggling with postpartum depression, we are dealing with disruptions in passionate love relationships. Depression is, in fact, only one potential cause of such disruption. Perhaps our conversation should focus on relationships from the beginning. Education material about PPD does address the impact of PPD on child development, but the language is often focused on the caregiver, rather than the caregiver-child relationship.

Across the ocean in Scotland my friend and colleague Suzanne Zeedyk has had a good deal of success in calling attention to the need to support early parent-child relationships. The departments of education, health care, finance and even law enforcement are on board in recognizing this need. On her website under "what I do" she writes:
Science is helping us to better understand how relationships shape the development of human brains and human communities. I make this knowledge understandable for parents, professionals and policymakers
Suzanne has created a beautiful DVD, The Connected Baby. There is a live streaming of the film today March 1st on the blog Mothering.com. One segment entitled "The Dance of the Nappy" films a mother changing her baby's diaper, interspersing commentary. In this simple and elegant way she shows the exquisite attunment between mother and baby that goes on in countless minute to minute interactions throughout the day. It is in this relationship that a baby's brain grows and develops. It is how he develops a sense of himself.

Her film does not address disruptions in relationships. But it is only a small step from there to understand that if a mother is depressed or anxious, or in some other way preoccupied, this dance will be significantly altered. Equally important to consider is the way in which qualities in the baby may disrupt the dance. In my previous post I wrote about regulatory and sensory processing difficulties. A baby may be sensitive to touch or sound, or struggle going from awake to asleep, or any of a range of qualities that may make negotiating the big, loud, complex world more challenging. If, in addition, his caregiver is struggling with depression, the dance may be further disrupted. Or the problems in the baby may cause depression in the mother, as when the baby cries all the time and the mother never sleeps.

When these disruption are not addressed early, significant problems may develop. As I write in my book Keeping Your Child in Mind:
When I see older children for behavior problems, I often hear stories from mothers who struggled terribly when their children were very young infants. Sometimes the memories are vague, but these mothers often recall vividly the sense of being completely alone. The most dramatic example of this was a mother with severe postpartum depression whose father suddenly died when her baby was three months old. Much to my astonishment, she described being relieved by this event. It wasn’t because she didn’t love her father. Rather, in sharing the grief with her siblings, mother, and extended family, she no longer felt so terribly alone. In order for mothers to be available for the kind of preoccupation their newborns need, they must not be left alone. If I were to give one piece of advice to mothers, families, and our culture as a whole, it would be to recognize that although what a mother does with her newborn may look ordinary, it is in fact extraordinary and deserves to be valued as such.
The MA commission is doing important work to call attention to this issue of PPD that is so critical not only for the health and well being of new mothers and fathers, but for the next generation as well. This commission offers an important opportunity to broaden the conversation. An investment in resources that support early caregiver-child relationships is an investment in the future of our country.

1 comment:

  1. Congratulations, Claudia,

    I'm glad you're on this commission. I worry that the final recommendations might shorten interval between birth and a prescription for an SSRI. I know your work well enough to know that you will emphasize understanding what the birth of the child means to the mother - how it 'works' for her, as the jargon would put it. Good luck.

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